Appointment scheduling management system

ABSTRACT

Provided are mechanisms and processes for a medical appointment delay management system. According to various examples, the system includes a location sensor that detects when a medical professional wearing a personal beacon enters an examination room to conduct an examination of a particular patient. The system also includes a medical schedule processor that logs a time associated with when the medical professional enters the examination room and compares this time with scheduling information to predict whether future appointments in the schedule will be delayed. A notification interface, included in the system, is designed to notify an upcoming patient if their scheduled appointment will be substantially delayed. Scheduling information is cryptographically separated from HIPAA information.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 14/794,857 filed Jul. 9, 2015, which is entirely incorporatedby reference herein.

BACKGROUND

Medical appointments are commonly associated with notoriously long waittimes. According to numerous reviews from patients, the number onecomplaint is the wait time to see the doctor. For instance, onlinereview sites allow patients to comment and provide corresponding starratings for service providers. On these sites, low star ratings forphysicians are often associated with comments citing long wait times.Often, reviewers complain of waiting from between thirty minutes to twohours. These reviews indicate that patient satisfaction with aphysician's care can be heavily influenced by wait times, and thatexcessive wait times can lead to negative reviews of a physician'sservices.

Accordingly, improving the wait time for a patient can greatly improvethe patient's satisfaction with the physician. In turn, thissatisfaction will improve the patient's subjective feelings about theircare, which can lead to more effective treatment and service.Specifically, when the patient is in a positive frame of mind at thebeginning of the examination, the appointment naturally flows moresmoothly. In addition, physicians often note that when they are behindschedule, they often spend time apologizing to the patient about beinglate, which reduces the amount of time available for actual patientcare. By reducing or eliminating patient wait times, physicians can bemore efficient and patients can have more positive experiences atappointments. Consequently, there is a need for improving patient waittimes for medical appointments.

SUMMARY

Provided are various mechanisms and processes relating to an appointmentscheduling management system. Although medical scheduling is used as amain example, those of ordinary skill in the art will recognize that thesame problems may exist in any appointment-based service practice(including but not limited to dental, veterinary, legal, accounting,counseling, cosmetology, photography or auto repair concerns) and mayaccordingly be addressed by the subject matter of this disclosure.

In one aspect, which may include at least a portion of the subjectmatter of any of the preceding and/or following examples and aspects,provided systems may include a first beacon transmitting a first signal;a clock providing a local time, a memory storing at least a firstscheduled time, a second scheduled time, and a delay threshold; a firstsensor reactive to the first signal and to a position or motion of thefirst beacon; a processor coupled to the first sensor, the clock, andthe memory; an appointment database coupled to at least one of thememory or the processor and comprising patient contact information and adate and time of at least one open appointment slot; a delay log coupledto the memory and accessible through an office interface; and acomputing device programmed to display the office interface.

The first scheduled time and the second scheduled time may be differenttimes at which the first sensor is expected to detect the first signal.The processor may include logic capable of subtracting the firstscheduled time from the local time to compute a first delay, sending thefirst delay to the delay log, comparing the first delay to the delaythreshold, and overwriting the second scheduled time if the first delayis greater than the delay threshold;

In some embodiments, a system may include a patient notificationinterface coupled to the memory, the appointment database, and at leastone patient device. The patient device may include a telephone and thepatient notification interface may alert a patient to the first delay bya text message or a voicemail. Alternatively, the patient device mayinclude a computing device and the patient notification interface mayalert a patient to the first delay by an email or a push notification.

In some embodiments, the patient notification interface may send detailsof the open appointment slot to the patient device. The patientnotification interface may accept a rescheduling message from thepatient device and responsively update at least one of the secondscheduled time or the appointment database. The patient notificationinterface may cause the patient device to display options of keeping orrescheduling a delayed appointment.

In some embodiments, the first sensor may be coupled to activate analert in response to the first beacon passing through a doorway. Thefirst sensor may remain in or with an examination room or treatmentroom. The first beacon may be carried or worn by a first medical workeror first patient, and the processor may capture the local time andcompute the first delay in response to the first sensor detecting anentry or an exit of the first beacon into or out from the examinationroom or treatment room. Alternatively, the first sensor may be carriedor worn by the first medical worker or first patient while the firstbeacon remains in or with the examination room or treatment room.

In some embodiments, the system may also include a second sensor carriedor worm by a second medical worker or second patient The processor maycapture the local time and compute the first delay in response to achange in the first signal as detected by the first sensor or the secondsensor.

According to various examples, provided non-transitory machine-readableinformation storage media may include code that, when executed, causes amachine to detect a position or a motion of a first beacon relative toan examination or treatment room and log a local time when the firstbeacon enters or exits the examination or treatment room during a firstappointment. The code may additionally cause the machine to retrieve afirst scheduled time associated with the entry or exit, subtract thefirst scheduled time from the local time to estimate a first delay, andcompare the first delay to a first threshold.

If the first delay is greater than the first threshold, the code maycause the machine to retrieve a second scheduled time associated with asecond appointment, add the first delay to the second scheduled time tocompute a revised time associated with the second appointment, andnotify a communication device that the second appointment will bedelayed until the revised time.

In some embodiments, the code may cause the communication device todisplay a selectable “keep” option and a selectable list of openappointment slots. If a user selects the “keep” option, the code maycause the system to replace the second scheduled time with the revisedtime. If the user selects a substitute appointment from the list of openappointment slots, the code may cause the system to cancel the secondappointment and assign the substitute appointment to a patient formerlyholding the second appointment,

In some embodiments, the communication device may include a mobiledevice. The communication device may include a remote device used by thepatient or a computing device used by office staff.

In some embodiments, the code may cause the machine to determine whetherthe detected entry or exit is a gating event (i.e., an event thatdefinitively indicates an expected delay of the next appointment). Ifthe detected entry or exit is not a gating event, the code may cause themachine to return to detection rather than use the non-gating event tocalculate a possibly inaccurate delay. In some embodiments, the delaysare only computed from the local times of gating events. Optionally, thegating event may be identified after a subsequent confirming event isdetected; e.g., detecting an entry of Patient B into the exam room(confirming event) confirms that the last detected exit of previousPatient A from the exam room was the end of Patient A's appointment(gating event).

In some embodiments, the code may include instructions for programmingthe first beacon to transmit an identity signal associated with awearer, so that each wearer's beacon transmits a differentdistinguishable signal. The code may then cause the machine to log acorresponding wearer identity along with the local time upon detectingan entry or exit. Optionally, delay log entries may be stored in adatabase. The database may be analyzed to identify frequent causes,lengths, or types of appointment delays so that bottlenecks and the likecan be mitigated and the office can potentially improve its on-timeperformance.

Embodiments of the system and software may be scaled for virtually anysize of practice, and may include contingencies for variations in thepractice's routine.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart illustrating one example of a patient appointmentsequence.

FIGS. 2A-2E are diagrams illustrating one example of a system ofsensors, identifiers, and their signals.

FIG. 3 is a swim-lane diagram of propagating delays of appointments.

FIGS. 4A-4C are flow sequences illustrating one example of a process forestimating delays for a medical appointment.

FIG. 5 is a swim-lane diagram of compensated delays of appointments.

FIG. 6 is a flow sequence illustrating another example of a process forestimating delays for a medical appointment.

FIGS. 7A-7C illustrate examples of user interface screens for theappointment management system.

FIG. 8 is a swim-lane diagram of multiple entries and exits of the sameindividuals to and from an examination room in the course of a singleappointment.

FIG. 9 is a flow sequence illustrating another example of a process forestimating delays for a medical appointment.

FIGS. 10A-10C are diagrams illustrating one example of a system in whichsensors are worn by patients and identifier beacons are worn byemployees and placed in service locations.

FIG. 11 is a diagrammatic representation of one example of a databasedesigned to store patient information.

FIG. 12 is a diagrammatic representation of one example of a medicalscheduling management system.

FIG. 13 is a diagrammatic representation of another example of a medicalscheduling management system.

DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS

Reference will now be made in detail to some specific examples of theinvention including the best modes contemplated by the inventors forcarrying out the invention. Examples of these specific embodiments areillustrated in the accompanying drawings. While the invention isdescribed in conjunction with these specific embodiments, it will beunderstood that it is not intended to limit the invention to thedescribed embodiments. On the contrary, it is intended to coveralternatives, modifications, and equivalents as may be included withinthe spirit and scope of the invention as defined by the appended claims.

For example, the techniques of the present invention will be describedin the context of particular scheduling mechanisms for medical offices.However, it should be noted that the techniques of the present inventionapply to a wide variety of different scheduling mechanisms for a varietyof different types of service entities such as dental offices, visionservice providers, etc. In the following description, numerous specificdetails are set forth in order to provide a thorough understanding ofthe present invention. Particular example embodiments of the presentinvention may be implemented without some or all of these specificdetails. In other instances, well known process operations have not beendescribed in detail in order not to unnecessarily obscure the presentinvention.

Various techniques and mechanisms of the present invention willsometimes be described in singular form for clarity. However, it shouldbe noted that some embodiments include multiple iterations of atechnique or multiple instantiations of a mechanism unless notedotherwise. For example, a system uses a processor in a variety ofcontexts. However, it will be appreciated that a system can use multipleprocessors while remaining within the scope of the present inventionunless otherwise noted. Furthermore, the techniques and mechanisms ofthe present invention will sometimes describe a connection between twoentities. It should be noted that a connection between two entities doesnot necessarily mean a direct, unimpeded connection, as a variety ofother entities may reside between the two entities. For example, aprocessor may be connected to memory, but it will be appreciated that avariety of bridges and controllers may reside between the processor andmemory. Consequently, a connection does not necessarily mean a direct,unimpeded connection unless otherwise noted.

Medical appointments are commonly associated with notoriously long waittimes. Because patient satisfaction with a physician's care can beheavily influenced by wait times, excessive wait times can lead tonegative reviews of a physician's services. By reducing or eliminatingpatient wait times, physicians can be more efficient and patients canhave more positive experiences at medical offices. The same applies toother providers of services by appointment whose schedules may besubject to delays for various reasons.

Accordingly, various embodiments of the present invention address theissue of wait times in medical offices. In some examples, a physician'sprogress is monitored and any delays in the physician's schedule aredetected. Patients are then informed of any delays or schedule changesin real-time. Specifically, a medical scheduling management systemtracks the physician's progress and provides notifications, such asthrough text messages, to upcoming patients. These notifications can letpatients know when a physician is running behind and ask them to arrivelater than their originally scheduled appointment.

By notifying patients in real-time about schedule changes orfluctuations, the intent is to decrease the amount of time that eachpatient waits for their appointment to begin. In turn, reducing the waittime should increase patient satisfaction and result in more positiveexperiences with their physicians.

Because reimbursement according to programs like Medicare will be highlydependent on patient satisfaction in the future, the amount physicianswill be paid will be closely tied to their patients' satisfaction. Bykeeping patients informed of schedule status and changes, the systemdescribed in various examples of this disclosure has the potential toaddress one of the biggest problems with patient satisfaction: waittimes. If patient satisfaction is increased, then there is a higherlikelihood that physicians will be fully reimbursed for their work. Inaddition, higher patient satisfaction will also lead to more referralsfrom patients and more business for physicians.

According to various embodiments, physician and other service employeeactivities, movements, and locations can be automatically or manuallydetected to allow improved appointment scheduling. For example,appointment start times can be manually or automatically triggered whena physician enters or a room and characteristics of the appointment canbe used to determine whether later appointments need to be adjusted.

In particular embodiments, mechanisms for tracking physician or othermedical personnel activities, movements, and locations for schedulingappointments are firewalled from systems managing patient medical data.In some examples, different encryption mechanisms are used to encodepatient medical data and medical personnel scheduling data so thataccess to one system does not permit access to another system. In otherexamples, different networks such as different virtual networks ordifferent physical networks are used to transport the different types ofdata. According to various embodiments, patient medical data isencrypted during both storage and transmission using a differentmechanism from medical personnel tracking data.

With reference to FIG. 1, shown is a flow chart illustrating one exampleof a patient appointment sequence. As shown, a typical patientappointment sequence 100 begins when a medical assistant (or nurse insome cases), calls a patient at 101 from the waiting room. Variousembodiments will be described with reference to particular medicalpersonnel. However, it should be noted that numerous activities can beperformed by a variety of different medical professionals such asmedical staff, medical assistants, nurses, physician assistants,physicians, residents, etc. A variety of triggers can also be used toinitiate scheduling mechanisms, such as when a physician enters thepatient's examination room, when a physician leaves the patient'sexamination room, when a nurse brings a patient to an examination room,etc.

According to various embodiments, a medical assistant then takes thepatient to the examination room at 103. During the medical assistant'ssession with the patient, the medical assistant often collectsinformation such as vitals and other data at 105. This may includeaspects such as measuring temperature, blood pressure, and the like. Inaddition, this process can include weighing and measuring the height ofthe patient. In some cases, these measurements may be taken in a hallwayon the way to the examination room. The medical assistant may also askthe patient questions and take notes. The medical assistant then leavesthe examination room and leaves the patient's chart for the physician at107. The patient is then left alone in the examination room to wait forthe physician. This time may also be used for changing into a gown, etc.

Next, the physician enters the examination room at 109. The physicianperforms the exam at 111, and then exits the examination room at 113.This concludes the process and the patient changes clothes, ifappropriate, and collects their belongings before leaving theexamination room.

As described, a medical appointment includes various phases that mayinclude wait times. For instance, the patient may wait for a period oftime before the medical assistant initially calls the patient at 101.The patient may also wait for a period of time between the time themedical assistant leaves the room at 107 and the time the physicianenters the room at 109. Both of these wait times affect patientsatisfaction and can lead to complaints relating to patient care. Inaddition, the amount of time that a physician spends with a particularpatient, between blocks 109 and 113, affects whether future appointmentsthat day will be on time or delayed. Accordingly, the timing of variousphases of a patient appointment sequence can affect patient satisfactionand determine whether future appointments will be delayed.

FIGS. 2A-2E are diagrams illustrating one example of a system ofsensors, identifiers, and their signals.

With reference to FIG. 2A, shown is an example of a partialmedical-office floor plan with an example of the system installed.Physician 203, shown in office 230, is the wearer of physician'sidentifier 231. Physician's identifier (ID) 231 may be an active beaconor a non-powered readable tag such as an RFID or infrared tag. In thisexample, office 230 does not have any sensors; for example, it may beused for purposes that do not involve the presence of patients.

In some embodiments, only the physician might wear an ID if his or heravailability primarily affects a patient's waiting time. If more thanone person wears an identifier, each of the identifiers may optionallyexpose or transmit a unique parameter. The parameter may include thewearer's role (“Doctor”), name (“Dr. Smith”), or any other encodableinformation linking the detected ID with its wearer. Such identificationparameters allow the sensor to record who is entering or exiting aservice location as well as when they enter or exit.

In some embodiments, assistant 202 also wears an ID, distinguishable bythe sensor(s) as assistant's identifier 221. As illustrated, assistant'sidentifier 221 may be in position to be detected by door sensor 223 inwaiting room 220. Door sensor 223 may activate door alert 227 to keeppatients from inadvertently leaving with their IDs. Alternatively, doorsensor 223 may simply record entry and exit of ID-wearers through themain office door. Door sensor 223 is logged by remote processor 234,which has a dedicated clock 235 and transmitter/receiver 236. In someembodiments, remote processor 234 is a hub processor for multiplesensors.

Patient 201, who has the current appointment, waits in service location210, an exam room. Optionally, patient 201 may wear a patient'sidentifier 211. Patient ID 211 may help locate the patient in the officeif there is any confusion about where he or she is. Logging patient ID211's interactions with door sensor 223 may also isolate the variable ofpatient arrival time if the sensor data on appointment timing is to beanalyzed.

Also in exam room 210 is an exam-room sensor 213. As illustrated,exam-room sensor 213 is part of a self-contained sensor module 205,another optional configuration for location sensors. Also in sensormodule 205 are dedicated sensor processor 214, dedicated clock 215, andsensor transmitter/receiver 216.

Delays and other events logged by sensors may trigger alerts on officeemployees' devices (mobile or not). For practices that emphasize humancontact, that notification may be sufficient; an employee would thenpersonally contact a patient with a delayed upcoming appointment andexplain options. By contrast, in a practice that prefers to reachpatients via technology may use an embodiment that sends schedulingupdates to device 206 accessed by upcoming patient 204, a holder of alater appointment.

With reference to FIG. 2B, shown is a diagram of detection of a passivereadable ID. ID 231B does not have its own power source. Sensor 213Bemits signal 214B, which impinges on ID 231B and is returned as returnsignal 215B/. For example, ID 231B may be an RFID tag that, when withinrange of sensor 213B, takes power 214B from sensor 213B and uses it toemit its own signal 215B for detection by sensor 213B. As anotherexample, ID 231B may be a bar or QR code and sensor 213B may include ascanning laser. The laser beam 214B (e.g., an eye-safe low-powerinfrared laser) is reflected or scattered from a coded pattern (e.g., abarcode or QR code) on ID 231B. The reflected or scattered light goesback to sensor 213B as return signal 215B.

With reference to FIG. 2C, shown is a diagram of detection of an emittedsignal from an active beacon ID. ID 231C had its own power sourceenabling it to independently emit signal 215C toward sensor 213C. Forexample, beacons available at the time of this writing have dimensionson the order of 5-10 cm (2-4″), weights of less than 1 ounce, andline-of-sight ranges of a few centimeters to a few hundred meters,depending partially on whether their signals are Bluetooth™, BluetoothLow Energy (BTLE)™, ANT+™, IEEE 802.22™ IrDA™, NFC™ RFID™ Wi-Fi™,ZigBee™, wireless USB or HART, or some other signal type. Some activebeacons have built-in sensors for motion, light, magnetic fields, heat,and other quantities. A beacon with a built-in sensor could potentiallyfunction as either a beacon or a sensor, so that only one type of unitneeds to be ordered, deployed, and tracked. Some active beacons withbuilt-in processors and memory may be reprogrammed to change theirsignal characteristics, either to uniquely identify particular beaconsor to avoid interference with medical equipment. Such beacons may, forexample, be shared by employees whose shifts do not overlap or patientswhose appointments do not overlap. In either case, beacon 231C may bereprogrammed between uses to transmit the identifying parameter of thenext wearer rather than the preceding one.

With reference to FIG. 2D, shown is one type of sensor signal from whichentry and exit times may be derived. The sensor emits a signal 209D aslong as it detects an ID in range, and emits no signal (at least, nosignal associated with that particular ID) while the ID is out of range.This the processor will read upward transition 207D as an entry anddownward transition 218D as an exit.

With reference to FIG. 2E, shown is another type of sensor signal fromwhich entry and exit times may be derived. The sensor sends a firstpulse 209E at time 207E when an ID comes within the sensor's range,emits no signal associated with that particular sensor while it remainsinn range, then emits a second pulse at time 218E in response to the IDmoving out of the sensor range.

In some embodiments, it may be preferable to conserve beacon power; thisschema uses significantly less power than emitting a signal continuouslyas in FIG. 2D. Distinguishing between entry and exit may be done viapulse length, as here, but alternatively by frequency, number of pulses,attack/release waveform, or the like.

With reference to FIG. 3, shown is a swim-lane diagram of propagatingdelays in appointments. This figure graphically represents theappointment routine described with reference to FIG. 1. A single sensorin the exam room monitors the progress of the appointment. At time 311,the assistant (long-dash line 302) brings the patient (solid line 301)into the exam room. After some time taking vital signs and the like,assistant 302 leaves the exam room at time 321, leaving patient 301 inthe exam room waiting for the physician. The physician (short-dash line303) enters the exam room at time 331, performs the exam, and leaves attime 341.

Horizontal fine solid lines 311, 321, 331, 341 and 351 represent localtimes logged when actual entries or exits are detected. Therefore, theycoincide with times at which the thicker lines representing thelocations of physician 303, assistant 302, and patient 301, crossbetween the “Out of Exam Room” lane (i.e., out of the detection range ofan exam-room sensor) and the “In Exam Room” line (i.e., in thedetectable range of the exam-room sensor). By contrast, horizontal finedotted lines 310, 320, 330, and 340 represent the scheduled entry andexit times. These times are stored in advance when the day's schedule isprepared, then retrieved to calculate a delay after each correspondingactual entry or exit occurs. For example, assistant 302 was scheduled toescort the patient into the exam room at time 310, but did not actuallydo so until time 311; the appointment is already running behindschedule.

In this example, delays propagate: every subsequent delay is either thesame length or longer than the immediately previous delay. Besidescomputing the delay between the scheduled and actual events, someembodiments of the process compare the delay to a stored threshold 305.Thresholding prevents excess notifications of employee and patientdevices when the delay is deemed too small to cause patients ofemployees to change his or her plans. Digital clocks can measure delaysof tiny fractions of a second, but humans, depending on the situation,may consider delays of less than a few minutes—or even delays of lessthan ½ hour—too small to warrant rescheduling the appointment. Setting athreshold 305 allows employees and upcoming patients to go about theirday without being distracted by alerts about delays too small to causeconcern.

FIGS. 4A-4C illustrate examples of flow sequences of processes forestimating delays for a medical appointment. The processes shown in eachof the figures can be used alone or together, depending on theapplication. For instance, the process shown in FIG. 4A can be usedalone in some examples, whereas, FIGS. 4A-4C can be combined in otherexamples. In some aspects, the notification system can be viewed as avirtual waiting room. The system tracks when appointments are runninglate and the system informs an upcoming patient that their appointmentis delayed and that they should delay arrival by a certain amount oftime.

With reference to FIG. 4A, shown is a flow sequence illustrating oneexample of a process for estimating delays for a medical appointment. Inthis example, delays in the schedule are estimated based on the timethat a medical assistant (or nurse) begins an appointment with apatient. According to various embodiments, scheduling times, activityand location tracking, event monitoring, and other triggers pertinent tomaintaining on-time scheduled appointments are referred to herein asscheduling information. In this process, estimating delays for a medicalappointment 400A begins with logging a location and time when a medicalassistant begins an appointment with a patient at 401A. Next, thislogged location and time is compared to a schedule at 403A. Thisschedule includes the patients and times for their appointments for thecurrent day. Based on this comparison, a determination is made whetherthe appointment is on time or substantially delayed at 405A. Forinstance, if the time that the medical assistant begins the appointmentis less than thirty (30) minutes later than the scheduled time for thispatient, the appointment can be categorized as being on time and theprocess ends. If the time that the medical assistant begins theappointment is thirty (30) minutes or more past the scheduled time forthis patient, then the appointment can be considered to be substantiallydelayed and the process continues at 407A. Although thirty (30) minutesis used in this example to determine whether the appointment is on time,any amount of time can be used. In some examples, this amount of timecan be set by a particular medical professional based on theirpreferences and office procedures.

In the present example, if the appointment is delayed thirty (30) ormore minutes, a determination is then made whether the appointment isunacceptably behind schedule at 407. For the sake of this example, two(2) hours is used as a measure of when an appointment is unacceptablybehind schedule. Appointments unacceptably behind schedule will notleave enough time for upcoming appointments, and consequently, willrequire that the upcoming appointments be rescheduled. Although two (2)hours delay is used as the threshold for determining when upcomingappointments need to be rescheduled, any amount of time can be useddepending on the particular application of the system. For instance,certain physicians may want to decrease this time based on theirallotted examination times or to generally increase patientsatisfaction.

In the current example, if the delay is less than two (2) hours, thendelays for upcoming appointments are then estimated and these upcomingpatients are notified of these delays at 409. For these upcomingpatients, the delay is between thirty (30) minutes and two (2) hoursbased on the current patient. In some examples, the delay can bepropagated through the schedule equally. Specifically, if the currentappointment is behind forty (40) minutes, then all of the upcomingappointments can be shifted forty (40) minutes later. However, in someexamples, each subsequent appointment can be shifted a certain amount inaddition to this forty (40) minutes if the system estimates that thephysician will incur additional delays from the subsequent appointments.Once the delay is estimated for the upcoming patients, the patients arethen notified.

According to various embodiments, upcoming patients are notified at 409Ausing their contact information. As described in more detail with regardto FIG. 11, this contact information can be stored in a database andaccessed by the notification system. This contact information can bekept separate from patient medical records, in order to avoid anyprivacy concerns regarding the federal Health Insurance Portability andAccountability Act of 1996 (HIPAA) or similar medical privacy laws inother nations. Specifically, the notification system accesses thecontact information for upcoming patients, such as a phone number. Insome examples, the notification system sends a text message to theupcoming patients notifying them of the expected delay and a later timethat they should arrive. For instance, an upcoming patient originallyscheduled for a two o'clock appointment may receive the followingmessage: “Dear Jane, your appointment originally scheduled for 4:00 pmtoday with Dr. Smith is running behind schedule. Could you please arriveat 4:45 pm instead? Sorry for the delay. Thank you for yourunderstanding.” Alternatively, the notification system can send avoicemail or email to upcoming patients, depending on factors such asthe patients' contact preferences and the office infrastructure.According to various embodiments, scheduling information such as medicalprofessional location tracking, appointment start triggers, eventmonitoring, etc., are cryptographically separated from HIPAAinformation.

According to various embodiments, medical professional activities,movements, and locations can be automatically or manually detected toallow improved appointment scheduling. For example, appointment starttimes can be manually or automatically triggered when a physician entersor a room and characteristics of the appointment can be used todetermine whether later appointments need to be adjusted. In particularembodiments, mechanisms for tracking physician or other medicalpersonnel activities, movements, and locations for schedulingappointments are firewalled from systems managing patient medical data.In some examples, different encryption mechanisms are used to encryptHIPAA data and scheduling information so that access to one system doesnot permit access to another system. In other examples, differentnetworks such as different virtual networks or different physicalnetworks are used to transport the different types of data. According tovarious embodiments, patient medical data is encrypted during bothstorage and transmission using a different mechanism from medicalpersonnel tracking data.

In the present example, if the delay is two (2) hours or more, then adetermination is made whether some or all of the upcoming patients forthe day need to be rescheduled. The patients that need rescheduling arethen notified at 411A and are offered an opportunity to reschedule theirappointments. For instance, if the physician is behind two hours, butcan cancel two upcoming appointments and be back on schedule withsubsequent patients, these two appointments may need to be rescheduled.In some cases, the schedule can be rearranged to cause as fewreschedules as possible. In some examples, the option to reschedule canbe offered through the text message, email, or voice message. Forinstance, an interactive sequence can be presented to the patient toallow them to reschedule immediately. This can provide convenience forboth the patients and the front office. Specifically, in some examples,one or more alternative times can be offered to the patient and thepatient can select one. Once the patient is notified according to thedescribed process (or if no delay is found), the process either ends orcontinues as described in FIG. 4B, depending on the desired applicationof the system.

With reference to FIG. 4B, shown is a flow sequence illustrating anotherexample of a process for estimating delays for a medical appointment. Inthis example, delays in the schedule are estimated based on the timethat a physician begins an appointment with a patient. This process canbe used alone in some examples, or it can continue following the processdescribed above with regard to FIG. 4A.

In the present example, estimating delays for a medical appointment 400Bbegins with logging a location and time when the physician begins anappointment with a patient at 401B. Next, this logged location and timeis compared to a schedule at 403B. This schedule includes the patientsand times for their appointments for the current day. Based on thiscomparison, a determination is made whether the appointment is on timeor substantially delayed at 405B. For instance, if the time that thephysician begins the appointment is less than thirty (30) minutes laterthan the scheduled time for this patient, the appointment can becategorized as being on time and the process ends. If the time that thephysician begins the appointment is thirty (30) minutes or more past thescheduled time for this patient, then the appointment can be consideredto be substantially delayed and the process continues at 407B.

Although thirty (30) minutes is used in this example to determinewhether the appointment is on time, any amount of time can be used. Insome examples, this amount of time can be set by a particular medicalprofessional based on their preferences and office procedures.

In the present example, if the appointment is delayed thirty (30) ormore minutes, a determination is then made whether the appointment isunacceptably behind schedule at 407B. For the sake of this example, two(2) hours is used as a measure of when an appointment is unacceptablybehind schedule. Appointments unacceptably behind schedule will notleave enough time for upcoming appointments, and consequently, willrequire that the upcoming appointments be rescheduled. Although two (2)hours delay is used as the threshold for determining when upcomingappointments need to be rescheduled in the present example, any amountof time can be used depending on the particular application of thesystem. For instance, certain physicians may want to decrease this timebased on their allotted examination times or to generally increasepatient satisfaction.

In this example, if the delay is less than two (2) hours, then delaysfor upcoming appointments are then estimated and these upcoming patientsare notified of these delays at 409B. For these upcoming patients, thedelay is between thirty (30) minutes and two (2) hours based on thecurrent patient. In some examples, the delay can be propagated throughthe schedule equally. Specifically, if the current appointment is behindforty (40) minutes, then all of the upcoming appointments can be shiftedforty (40) minutes later. However, in some examples, each subsequentappointment can be shifted a certain amount in addition to this forty(40) minutes if the system estimates that the physician will incuradditional delays from the subsequent appointments. Once the delay isestimated for the upcoming patients, the patients are then notified. Insome examples, if multiple factors are used to determine scheduledelays, such as the time that the medical assistant begins theappointment and the time that the physician begins the appointment, thenonly one notification may be provided. For instance, a step can beincluded that determines whether a notification has already been sent tothis patient, and if so, then an additional notification will not besent. In other examples, updates to this notification with currentwaiting times and real-time appointment adjustments can be made asupdated delays are predicted.

According to various embodiments, upcoming patients are notified at 409using their contact information. As described in more detail with regardto FIG. 11, this contact information can be stored in a database andaccessed by the notification system. This contact information can bekept separate from patient medical records, in order to avoid anyprivacy concerns regarding the federal Health Insurance Portability andAccountability Act of 1996 (HIPAA).

Specifically, the notification system accesses the contact informationfor upcoming patients, such as a phone number. In some examples, thenotification system sends a text message to the upcoming patientsnotifying them of the expected delay and a later time that they shouldarrive. For instance, a patient later in the day scheduled for a twoo'clock appointment may receive the following message: “Dear Jane, yourappointment originally scheduled for 2:00 pm today with Dr. Smith isrunning behind schedule. Could you please arrive at 2:45 pm instead?Sorry for the delay. Thank you for your understanding.” Alternatively,the notification system can send a voicemail or email to upcomingpatients, depending on factors such as the patients' contact preferencesand the office infrastructure.

In the present example, if the delay is two (2) hours or more, then adetermination is made whether some or all of the upcoming patients forthe day need to be rescheduled. The patients that need rescheduling arethen notified at 411B and are offered an opportunity to reschedule theirappointments. For instance, if the physician is behind two hours, butcan cancel two upcoming appointments and be back on schedule withsubsequent patients, these two appointments may need to be rescheduled.In some cases, the schedule can be rearranged to cause as fewreschedules as possible. In some examples, the option to reschedule canbe offered through the text message, email, or voice message. Forinstance, an interactive sequence can be presented to the patient toallow them to reschedule immediately. This can provide convenience forboth the patients and the front office. Specifically, in some examples,one or more alternative times can be offered to the patient and thepatient can select one. Once the patient is notified according to theprocess (or if no delay is found), the process either ends or continuesas described in FIG. 4C, depending on the desired application of thesystem.

In the present example, although both a location and time are loggedwhen the physician begins the appointment, it should be noted that insome embodiments, the location need not be logged. For instance, if thepatient and time are adequately identified and logged, then the locationdoes not need to be logged in order to compare the actual appointmenttime with the scheduled appointment time. According to various examples,the location log can be used to determine when a physician is seeing aparticular patient. Specifically, in cases where location logging isautomated, such as with sensors, GPS, or the like, then the location canprovide information about which patient a physician is currently seeing.

With reference to FIG. 4C, shown is a flow sequence illustrating anotherexample of a process for estimating delays for a medical appointment. Inthis example, delays in the schedule are estimated based on the timethat a physician ends an appointment with a patient. This process can beused alone in some examples, or it can continue following the processdescribed above with regard to FIGS. 4A and/or 4B.

In the present example, estimating delays for a medical appointment 400Cbegins with logging a location and time when the physician ends anappointment with a patient at 401C. Next, this logged location and timeis compared to a schedule at 403C. This schedule includes the patientsand times for their appointments for the current day. Based on thiscomparison, a determination is made whether the appointment is on timeor substantially delayed at 405C. For instance, if the time that thephysician ends the appointment is less than thirty (30) minutes laterthan the scheduled time for this patient plus the allotted duration ofthis type of appointment, the appointment can be categorized as being ontime and the process ends. If the time that the physician ends theappointment is thirty (30) minutes or more past the scheduled time forthis patient plus the allotted duration of this type of appointment,then the appointment can be considered to be substantially delayed andthe process continues at 407C. Although thirty (30) minutes is used inthis example to determine whether the appointment is on time, any amountof time can be used. In some examples, this amount of time can be set bya particular medical professional based on their preferences and officeprocedures.

In the present example, if the appointment is delayed thirty (30) ormore minutes, a determination is then made whether the appointment isunacceptably behind schedule at 407C. For the sake of this example, two(2) hours is used as a measure of when an appointment is unacceptablybehind schedule. Appointments unacceptably behind schedule will notleave enough time for upcoming appointments, and consequently, willrequire that the upcoming appointments be rescheduled. Although two (2)hours delay is used as the threshold for determining when upcomingappointments need to be rescheduled in the present example, any amountof time can be used depending on the particular application of thesystem. For instance, certain physicians may want to decrease this timebased on their allotted examination times or to generally increasepatient satisfaction.

In this example, if the delay is less than two (2) hours, then delaysfor upcoming appointments are then estimated and these upcoming patientsare notified of these delays at 409C. For these upcoming patients, thedelay is between thirty (30) minutes and two (2) hours based on thecurrent patient. In some examples, the delay can be propagated throughthe schedule equally. Specifically, if the current appointment is behindforty (40) minutes, then all of the upcoming appointments can be shiftedforty (40) minutes later. However, in some examples, each subsequentappointment can be shifted a certain amount in addition to this forty(40) minutes if the system estimates that the physician will incuradditional delays from the subsequent appointments. Once the delay isestimated for the upcoming patients, the patients are then notified. Insome examples, if multiple factors are used to determine scheduledelays, such as the time that the medical assistant begins theappointment and/or the time that the physician begins the appointment,then only one notification may be provided. For instance, a step can beincluded that determines whether a notification has already been sent tothis patient, and if so, then an additional notification will not besent. In other examples, updates to this notification with currentwaiting times and real-time appointment adjustments can be made asupdated delays are predicted.

According to various embodiments, upcoming patients are notified at 409Cusing their contact information. As described in more detail with regardto FIG. 11, this contact information can be stored in a database andaccessed by the notification system. This contact information can bekept separate from patient medical records, in order to avoid anyprivacy concerns regarding the federal Health Insurance Portability andAccountability Act of 1996 (HIPAA).

Specifically, the notification system accesses the contact informationfor upcoming patients, such as a phone number. In some examples, thenotification system sends a text message to the upcoming patientsnotifying them of the expected delay and a later time that they shouldarrive. For instance, an upcoming patient scheduled for a two o'clockappointment may receive the following message: “Dear Jane, yourappointment originally scheduled for 2:00 pm today with Dr. Smith isrunning behind schedule. Could you please arrive at 2:45 pm instead?Sorry for the delay. Thank you for your understanding.” Alternatively,the notification system can send a voicemail or email to upcomingpatients, depending on factors such as the patients' contact preferencesand the office infrastructure.

In the present example, if the delay is two (2) hours or more, then adetermination is made whether some or all of the upcoming patients forthe day need to be rescheduled. The patients that need rescheduling arethen notified at 411C and are offered an opportunity to reschedule theirappointments. For instance, if the physician is behind two hours, butcan cancel two upcoming appointments and be back on schedule withsubsequent patients, these two appointments may need to be rescheduled.In some cases, the schedule can be rearranged to cause as fewreschedules as possible. In some examples, the option to reschedule canbe offered through a text message, email, voice message, or pushnotification. For instance, an interactive sequence can be presented tothe patient to allow them to reschedule immediately. This can provideconvenience for both the patients and the front office. Specifically, insome examples, one or more alternative empty appointment time slots canbe offered to the patient and the patient can select one. Once thepatient is notified according to the process described (or if no delayis found), the process ends.

In the present example, although both a location and time are loggedwhen the physician ends the appointment, it should be noted that in someembodiments, the location need not be logged. For instance, if thepatient and time are adequately identified and logged, then the locationdoes not need to be logged in order to compare the actual appointmenttime with the scheduled appointment time. According to various examples,the location log can be used to determine when a physician is seeing aparticular patient. Specifically, in cases where location logging isautomated, such as with sensors, GPS, or the like, then the location canprovide information about which patient a physician is currently seeing.

In some embodiments, multiple processes described with regard to FIGS.4A-4C can be used to provide feedback to the physician about scheduleefficiencies or inefficiencies. For instance, data can be gathered andstatistics can be generated for a particular day showing how manyappointments were delayed, by how much, and whether the delays werecaused by medical assistant delay, physician delay, or appointments thatran longer than the allotted time for the type of exam that wasperformed. In addition, statistics can be provided over periods oftimes, from days to months to years, depending on the time specified. Insome examples, graphs and/or charts can be provided that show trends.Furthermore, suggestions can be provided based on the data provided,such as whether actual examination times are exceeding the allottedtimes, and by how much. Percentages can be provided showing how muchoverrun is occurring and how often. Suggestions such as extending theallotted times for examinations or spacing appointments further apartmay be provided.

With reference to FIG. 5, shown is a swim-lane diagram of compensateddelays in appointments. FIG. 3, discussed above, illustrated propagatingdelays; for successive entries or exits, the delay either remainedconstant or increased. Delays may not always propagate, however; a delaymay be “made up” if a process takes less than the expected time (e.g., apatient arrives with a questionnaire already filled out) or is cancelledaltogether (e.g., if a patient “noshows” or reschedules only a few hoursbefore the appointment). Assistant 502 is scheduled to bring patient 501to the exam room. at time 510, but does not actually do so until latertime 511; the appointment is running behind schedule. After some timetaking vital signs and the like, assistant 502 is scheduled to leave theexam room at time 520, but does so at earlier time 521 so that now theappointment is ahead of schedule. Physician 503) is scheduled to enterthe exam room at time 530, but does not do so until later time 531, sothat the appointment is behind schedule again. However, physician 503leaves the exam room at time 541, which is equal to scheduled time 540,putting the appointment back on schedule.

The following appointment (and, barring further delays, the appointmentsfollowing it) may actually start on time. Meanwhile, though, a delaymessage may have been transmitted at time 511 (or possibly not if thissmall delay was sub-threshold. Depending on the embodiment, a“back-on-schedule” notification might have been transmitted at time 521,or the system may be programmed to ignore on-schedule events. Anotherdelay message may have been transmitted at time 531 (a longer delaylikely to exceed the threshold) and perhaps one or more patients decidedto reschedule, but at time 541 there was no longer a delay, therefore noactual need to incur the added overhead of the rescheduling.

Identification of gating events can smooth out such fluctuations inexpected delays. After leaving the exam room at time 541, physician 503is now free to see another patient (or will be after an allotted time to“wrap up” the current appointment). Thus the physician's exit from theexam room at time 541 may be the “gating event” that determines the endof the appointment, making it possible to estimate the beginning of thenext appointment. Therefore, in some embodiments the system may log allentries and exits, with or without comparing the logged time with thescheduled time, but it may refrain from transmitting delay messagesexcept when a gating event occurs.

With reference to FIG. 6, shown is a flow diagram of an operation thatmay be implemented as software. Operation 600 may include detecting aposition or motion of a first identifier within a sensor range, whereinthe sensor range at least partially covers a first service location. Achange in the sensor signal, which may include being turned on or off,triggers operations 601 a-c, which may include logging a local time 601a, optionally logging a sensor location 601 b (e.g., if there aremultiple sensors to distinguish or the sensor moves from one servicelocation to another), and logging a first identifying parameter of thefirst identifier (to identify the particular wearer) in response to anentry of the first identifier into the sensor range or an exit of thefirst identifier out of the sensor range.

Optional decision 610 may include determining whether the logged entryor exit is a gating event. If so, or if the gating-event determinationis omitted, operation 611 may include retrieving a scheduled time of theentry or the exit during a first appointment and subtracting the firstscheduled time from the local time to estimate a first delay.

Optional decision 620 may include comparing the first delay to athreshold. If the first delay is greater than the threshold, operation621 may include estimating the delay of upcoming patients' appointmentsby adding the first delay to the second scheduled time to compute theexpected time of the delayed appointment. Operation 623 may includenotifying a first device that the second appointment will be delayeduntil the expected time and optionally display a selectable “keep”option and a selectable list of open appointment slots on the firstdevice after the notifying. The device may be an employee device, anupcoming patient's device, or both. Selection may be done by typing,touching, clicking, voice, or any other suitable way to choose from aset of options using the device.

Optional decision 630 may calculate whether the delayed time of theday's last appointment has become so late that the office will closebefore the appointment is completed. If so, the holder of thatappointment may be offered rescheduling options but no “keep” option inoperation 631. Operation 625 updates the stored schedule for the rest ofthe day to account for the currently expected delay. The system mayrespond to an upcoming patient's selection of a “keep” option byreplacing the patient's current scheduled time with the expected time ofthe delayed appointment. Decision 640 determines whether an upcomingpatient has rescheduled and, if so, executes an updating operation 625replacing the patient's currently scheduled appointment with therescheduled appointment. In some embodiments, this step may be executedany time any patient requests a reschedule, rather than only in responseto a delay notification. Operation 612 returns the system to monitoringthe sensor(s) whenever there is no reason for a delay notification, suchas when the most recent event was not a gating event per decision 610 orwas not an above-threshold delay per decision 620. Finally, decision 650determines whether the last appointment of the day has been finished; ifso, the system responds by stopping the process, ceasing to monitor thesensor(s)

FIGS. 7A-7C illustrate examples of delay notifications displayed ondevice screens. Non-display notifications such as voice-mails are alsowithin the scope of some embodiments.

With reference to FIG. 7A, shown is a cell phone displaying a textmessage. Most cell phones 701 are able to display a text message 703,which may include details 705 of open appointment slots for reschedulingand enable the user to communicate a choice using the keypad.

With reference to FIG. 7B, shown is a smartphone displaying a pushnotification from an installed application (“app”). A smartphone 711 mayalso receive voicemail and text messages, but may include the additionalpossibilities of push notifications 713 or dedicated apps with graphicuser interfaces (GUIs). A GUI may display “Keep” option 715 and openslots 717 as buttons or other clickable or touchable features.

With reference to FIG. 7C, shown is a desktop computer displaying analert. As well as upcoming patients, employees of the medical office canalso benefit from delay notifications by organizing their tasks andbreaks around the times when the appointments are likely to begin andend, rather than when the appointments were originally intended to beginand end.

With reference to FIG. 8, shown is a swim-lane diagram of multipleentries and exits of participants in a single appointment. Previously itwas proposed that the physician's exit from the exam room might be thebest indicator of the appointment being over, and therefore a goodchoice of a gating event. However, if the physician exits the exam roommore than once during a single appointment, only the last such exit ispreferably used to calculate the delay.

For example, physician 803 exits the exam room at time 842, but onlytemporarily. Physician 803 may need to answer an urgent question, fetchan injectable, or the like. Shortly thereafter, physician 803 re-entersthe exam room, finishes his or her part of the appointment, and re-exitsat time 841. Meanwhile, the sensor detects exit 842 and may compute andcommunicate a delay based on exit time 842. Upon detecting the secondexit 841, the system may compare the local time with the NEXT scheduledphysician-exit time during the following appointment, which will yieldan inaccurate result.

Likewise, assistant 802 may enter the exam room at time 811, collectpreliminary information for the physician, and leave at time 821, thenenter again to answer logistics questions for an upcoming procedureafter the physician exits, and exit again at time 822. If this happensin some types of appointments but not in others, some systems mightchoose the wrong scheduled time to compare to the second exit.

Patient 801's exit from the exam room might be a better choice of gatingitem; the sensor would detect patient 801's exit at time 861, thenretrieve the log entry for the immediately preceding physician 803 exitat time 841 and calculate the delay from it. In this process, thepatient's exit is a “confirming event” signaling that the appointment isover and the physician's most recent exit is therefore the gating event.However, even patient 801 does not necessarily stay in the exam room forthe entire appointment. For example, the patient may exit at time 862 togive a sample or answer an administrative question, and then return tothe appointment.

Looking further ahead, patient 801's appointment must definitely be overwhen the next patient 811 enters the exam room at time 871. Therefore, asystem can avoid being “confused” by multiple entries and exits ofparticipants in a single appointment by using the entry of the nextpatient as a confirming event, retrieving the most recent physician exitbefore time 871, and using it to calculate the delay. This preventspatient 811 from getting updates on delays generated during patient801's appointment. However, because those updates would likely have beenexcessively short notice for patient 811 to change plans, the impact isminimal.

With reference to FIG. 9, shown is a flow diagram of a processaccommodating multiple entries and exits. An appointment begins withoperation 900 with a first patient entering the exam room. Operation 901may include logging entries and exits detected by the sensor.

After each logging operation, the system decides at decision 910 whetherthe most recent event confirms that the first patient's appointment hasended. In this example, the confirming event is the entry of a secondpatient into the exam room. If not, the system may return to operation910 of monitoring and logging, rather than performing delaycalculations. If so, operation 911 may include identifying the mostrecent event as a confirming event, therefore the last previousphysician exit was the gating event. Operation 913 may includeretrieving the local time and the scheduled time of the gating event.Decision 920 determines whether the difference between the gatingevent's local time and its corresponding scheduled time is greater thana stored threshold. If not, the system may return to operation 910 ofmonitoring and logging, rather than performing delay calculations. Ifso, operation 921 may include estimating a delay for upcomingappointments, followed by operation 923 of notifying devices, offeringreschedule options, and updating the schedule.

FIGS. 10A-10C illustrate an embodiment in which a patient carries asensor and the service locations, physicians, and assistants carryactive beacons. This type of system tracks the service locations that apatient visits—helpful in practices where patients spend time intreatment rooms, sample collection rooms, the physician's office orconference room, or elsewhere besides an exam room. The system alsotracks the time that physicians and assistants spend in proximity to thepatient, which may be helpful in settings where patients are examined,tested, or treated in cubicles or bays or at counters that are small andclose together with partial dividing walls or none at all.

With reference to FIG. 10A, shown is an example of a medical officefloor plan. Optionally, when patient 1001 checks in at reception 1010,office staff member 1006 may use machine 1016 to program an identifyingparameter into sensor 1013 that is unique to the patient or theappointment. Sensor 1013 has a sensor range 1043 which in someembodiments may be only 1-2 m (3-6′) and a built-in clock 1015 or accessto some other clock signal.

Assistant 1002 wears beacon 1021 emitting signal 1026, which is detectedby sensor 1013 when assistant 1002 escorts patient 1001 to exam room1020. In some embodiments, signal 1026 may include an identificationparameter associated with the assistant wearing it. When patient 1001enters exam room 1020, sensor 1013 detects exam-room beacon signal 1024from exam-room location beacon 1022. Signal 1024 may also include anexam-room identification parameter. When assistant 1002 exits the examroom, sensor 1013 stops detecting signal 1026 but continues detectingsignal 1024 because patient 1001 is still in exam room 1020.

Meanwhile, physician 1003 in office 1030 wears physician's beacon 1031transmitting physician's beacon signal 1033 while office location beacon1023 transmits office beacon signal 1034. When physician 1003 entersexam room 1020, sensor 1013 will begin to detect physician's beaconsignal 1033. If physician 1003 then escorts patient 1001 into office1030 for a conference, sensor 1013 will stop detecting exam-room beaconsignal 1024 and begin detecting office beacon signal 1034.

In some embodiments, patient 1001 may return sensor 1013 to member ofoffice staff 1006 when the appointment ends. The timing informationlogged by sensor 1013 may be uploaded to storage via machine 1016 orsome other device. Note that this approach may obviate the need forgating-even and confirming-event capture and the accompanyingcalculations; when the patient returns sensor 1013, the appointment maybe over by definition. Optionally, delay data over a span of time suchas a week or a month may be analyzed to diagnose any frequent causes ofdelay.

With reference to FIG. 10B, shown is a display interface 1051 forprogramming a patient sensor at the beginning of an appointment. Thepatient's record number, name, and/or appointment time may be used toidentify the log entries uploaded later. The patient arrival time mayhelp derive how many and what lengths of delays are generated whenpatients arrive late.

With reference to FIG. 10C, shown is a display interface 1052 foruploading data on patient entry and exit times a patient sensor at thebeginning of an appointment. Any or all of identifying parameters 1054may be used to label the data in a database.

With reference to FIG. 11, shown is a diagrammatic representation of oneexample of a database designed to store patient information. Asdescribed above with regard to FIGS. 4A-4C, contact information forpatients is retrieved by the notification system when upcoming patientsare to be notified of a delay in their appointment times. However, inorder to avoid any privacy concerns regarding HIPAA, the notificationsystem is limited to retrieving contact information that is not relatedto patient-sensitive information.

In the present embodiment, database 1100 includes patient appointmentinformation 1101 and patient medical records 1115. Patient appointmentinformation 1101 includes information for numerous patients such as name1103, date of birth 1105, account number 1107, appointment time(s) 1109,and contact information 1111. The contact information 1111 can includeinformation such as phone number(s) (for text and/or voicemail), emailaddress, mailing address, and residence address. Additional or differentinformation can be included, depending on the intended use of thedatabase. However, patient appointment information is intended toinclude information that can be accessed by a scheduling or frontoffice, without concerns about privacy under HIPAA. For example, patientappointment information 1101 may be accessed by an app 1135 onoffice-employee devices over a network 1137.

In some embodiments, appointment change status information 1141 may bestored in the non-HIPAA portion of the same database 1100. Appointmentchange status information 1141 may include, without limitation, lookuptable 1143 of the latest appointment times held by each patient; currentdelay information 1145 collected by sensors; available open slots 1147for patients who opt to reschedule their appointments; and contact infofor patients who need help with appointment schedule issues. Appointmentchange status information 1141 may be accessed by an app 1155 onpatients' devices over a network 1157, which may or may not be the sameas network 1137. In some embodiments, patients' option choices (e.g., tokeep a delayed appointment or to reschedule) are received in database1100 over network 1157.

In the present example, patient medical records 1115 are protected by afirewall 1102 that prevents inadvertent or unauthorized access topatient information protected under HIPAA. The patient medical records1115 include information for numerous patients such as diagnoses 1117,medications 1119, physician's notes 1121, confidential communications1123, and lab results 1125. Additional or different information can beincluded depending on the preferences of the physician or practice. Thepatient medical records 1115 may include sensitive information that isprotected under HIPAA privacy laws. Accordingly, this information mustbe handled carefully and access to it must be restricted to authorizedpeople and systems.

According to various embodiments described herein, a medical schedulingmanagement system notifies upcoming patients of a delay in theirappointment times by accessing patient appointment information such asname 1103, appointment time 1109, and contact information 1111. In someexamples, the notification system is implemented as an app for mobiledevices. This app 1135 retrieves 1137 patient appointment information topredict schedule delays, such as by retrieving appointment times 1109and comparing these appointment times 1109 to real-time appointmentprogress for a particular physician. In addition, this app 1135retrieves contact information 1111 and names 1103 for patients that areto be notified of upcoming schedule delays. As indicated in the figure,the app 1135 does not have access to patient medical records 1115, andis prevented from accessing these patient medical records 1115 byfirewall 1102. Although this example is described in the context of anapp that can be implemented on one or more smartphones, mobile devices,etc., it should be recognized that this notification system can beimplemented over any computer system. For instance, an office-basedcomputer system can be updated manually by a medical assistant or otherpersonnel to reflect current appointment times and the system canoperate without any mobile devices.

As described in previous examples, a medical scheduling managementsystem can be used to predict delays for upcoming appointments andnotify upcoming patients of these delays. The medical schedulingmanagement system can be implemented in various ways. FIGS. 12 and 13illustrate two examples of configurations for medical schedulingmanagement systems. It should be noted that although two particularexamples are described, modifications and adjustments can be made withinthe scope of this disclosure.

With reference to FIG. 12, shown is a diagrammatic representation of oneexample of a medical scheduling management system. The medicalscheduling management system 1200 shown includes identifier 1250,location sensor 1201, clock 1202, memory 1203, medical scheduleprocessor 1205, delay log interface 1207, employee interface 1213,employee device(s) 1209, and patient notification interface 1211. Thelocation sensor 1201 is designed to detect when a medical professionalenters an examination room to conduct an examination of a particularpatient. Clock 1202 tracks the local time that is captured by processor1205 when sensor 1202 detects the appearance or disappearance of anidentifier. This location sensor 1201 can be implemented in numerousways. In one example, a medical professional wears an identifier 1250that is detectable in different areas of the office. The system is ableto detect when identifier 1250, such as an RFID, etc. is in proximity tothe location sensor. In some applications, there may be multipleidentifiers simultaneously detected by a sensor. The processor, byextracting identifying parameter 1251, can discern whose identifier wasdetected by sensor 1201. In some applications, there may be multiplelocation sensors in the system.

In other examples, the location sensor 1201 represents an inputinterface used by a medical assistant or other personnel to enter thelocation of the medical professional at a particular time. Specifically,location and time information can be entered manually into the system.In some instances, the location sensor 1201 represents an inputinterface used by the medical professional to indicate when a particularappointment has started. Specifically, location and time information canbe entered manually into the system. For instance, the next scheduledappointment may pop up or be otherwise selectable on a mobile device,and when the medical professional selects a button, the time is loggedand this time is compared with the scheduled time. In yet otherembodiments, the medical scheduling management system 1200 can beimplemented as an app on a mobile device, such as a smartphone. In theseexamples, the location sensor 1201 can implement technologies such asGPS or other location sensing systems. In some examples, the locationsensor 1201 can be omitted, such as when only the patients and times arelogged.

In the present embodiment, the medical schedule processor 1205 isdesigned to log the time when a medical professional enters anexamination room for a particular appointment and compare this time witha schedule to predict whether future appointments in the schedule willbe delayed. The schedule typically includes patients and times forappointments scheduled on a particular day. According to variousexamples, the schedule may not include any HIPAA information. The memory1203 is used to store data, which may include the present day's schedule1223 and stored thresholds 1233, store program instructions, andmaintain a local side cache. The program instructions may control theoperation of an operating system and/or one or more applications, forexample. In addition, display 1209 is used to allow a user to interactwith the system, such as through a monitor, screen, etc.

In the present embodiment, the notification interface 1211 is used tonotify upcoming patients if their appointments will be substantiallydelayed, as described in more detail with regard to FIGS. 4A-4C above.This notification interface 1211 is also designed to notify upcomingpatients if their appointments need to be rescheduled. In some examples,the notification interface 1211 is also designed to provide an optionfor these patients to reschedule their appointments. As described above,the notification interface 1211 contacts a patient device 1217 usingpatient contact information such as a phone number, email, etc. In someexamples, the notification interface 1211 notifies a patient via a textmessage. In other examples, the notification interface 1211 notifies apatient via a voicemail or email. Other notification modes can also beused, depending on the preferences of the patient and medical office.

In the present example, delay log interface 1207 allows data such asreal-time location and time information for appointments in-progress tobe transmitted to an appointment delay log 1213. This appointment delaylog 1213 is located in a separate location that may be accessed by otherdevices. For instance, if the medical scheduling management system 1200is implemented as an app on a mobile device, the appointment delay log1213 may include an office computer that is accessible to office staffand personnel. In other examples, the appointment delay log 1213 can belocated on a cloud drive. However, the delay log interface 1207 andappointment delay log 1213 can be omitted in some applications,depending on the needs of the practice.

As shown in the present embodiment, the medical scheduling managementsystem 1200 can interact with a patient appointment information database1215, such as the one shown and described with regard to FIG. 11.Patient appointment information database 1215 may include patientcontact information 1225 and open appointment slots 1235. In particular,the medical scheduling management system 1200 accesses the patientappointment information database 1215 when predicting delays, whennotifying upcoming patients by messaging their devices such as patientdevice 1217, and when notifying medical-office employees throughemployee interface 1213 via employee devices 1209. As mentioned withregard to FIG. 11, the information accessible in the patient appointmentinformation database 1215 is not data that is protected under HIPAA.

With reference to FIG. 13, shown is a diagrammatic representation ofanother example of a medical scheduling management system. In thisexample, the medical scheduling management system 1300 includes amedical scheduling management hub 1315 and one or more medicalprofessional mobile devices 1301. The medical professional mobile device1301 can be implemented as a mobile device, such as a smart phone,tablet, etc. In other examples, this mobile device 1301 can beimplemented as a wearable device such as a bracelet, fob, charm, clip,etc. As shown, the medical scheduling management hub 1315 is implementedon a computer such as a mobile device, office computer, server, etc.This serves as a “home base” for the system. In some examples, this hub1315 is implemented on a central office computer or on the cloud.

In the present example, the medical professional mobile device 1301includes a location sensor 1303, memory 1305, processor 1307, display1309, and notification hub interface 1311. The location sensor 1303 isdesigned to detect when a medical professional enters an examinationroom to conduct an examination of a particular patient. This locationsensor 1303 can be implemented in numerous ways. In one example, thelocation sensor is able to identify when the medical professional is indifferent areas of the office. In these examples, the location sensor1303 can implement technologies such as GPS, RFID, Bluetooth,triangulation mechanisms, cameras, or other location sensing systems. Inother examples, the location sensor 1303 represents an input interfaceused by the medical professional to indicate when a particularappointment has started. Specifically, location and time information canbe entered manually into the system. For instance, the next scheduledappointment may pop up or be otherwise selectable the mobile device1301, and when the medical professional selects a button, the time islogged and this time is compared with the scheduled time. In someembodiments, the location sensor 1303 can be omitted, such as when onlypatient and time information are logged.

In the present example, the medical professional mobile device 1301includes memory 1305, which is used to store data and programinstructions and maintain a local side cache. The program instructionsmay control the operation of an operating system and/or one or moreapplications, for example. In some examples, the size of the memory 1305may be limited, as when most of the processing and storage of data isperformed at the medical scheduling management hub 1315. In addition,the processor 1307 may include limited processing of the data collected.For instance, the data collected may include the times and locations ofparticular appointments, and the processor can be used to format theinformation before sending it to the medical scheduling management hub1315. The limited memory 1305 and processor 1307 sizes and capabilitiesmay be appropriate especially in cases when the medical professionalmobile device 1301 is implemented as a wearable because the componentscan be smaller and more conveniently designed into a smaller casing tobe comfortably worn. In the present example, display 1309 is used toallow the medical professional to interact with the system, such asthrough a screen, touch screen, etc. As described above, the medicalprofessional may input data through this display 1309 and/or viewoptions through the display.

In the present example, the medical professional mobile device 1301 alsoincludes a notification hub interface 1311. This notification hubinterface 1311 is used to communicate with the medical schedulingmanagement hub 1315. In particular, data regarding real-time appointmentstart times are sent via the notification hub interface 1311 to themedical scheduling management hub 1315 via medical professional deviceinterface 1321. In some examples, the medical professional deviceinterface 1321 is used to send messages to the medical professionalmobile device 1301 via the notification hub interface 1311, such as “Hasthe Smith 1:10 pm appointment begun?”

In the present embodiment, the medical scheduling management hubincludes a medical schedule processor 1317 designed to log the time whena medical professional enters an examination room for a particularappointment and compare this time with a schedule to predict whetherfuture appointments in the schedule will be delayed. The scheduletypically includes patients and times for appointments scheduled on aparticular day. According to various examples, the schedule does notinclude any HIPAA information. The memory 1319 is used to store data andprogram instructions and maintain a local side cache. The programinstructions may control the operation of an operating system and/or oneor more applications, for example. In addition, display 1323 is used toallow a user to interact with the system, such as through a monitor,screen, etc.

In the present embodiment, the patient notification interface 1325 isused to notify upcoming patients if their appointments will besubstantially delayed, as described in more detail with regard to FIGS.4A-4C above. This notification interface 1325 is also designed to notifyupcoming patients if their appointments need to be rescheduled. In someexamples, the notification interface 1325 is also designed to provide anoption for these patients to reschedule their appointments. As describedabove, the notification interface 1325 contacts a patient 1345 usingpatient contact information such as a phone number, email, etc. In someexamples, the notification interface 1325 notifies a patient via a textmessage. In other examples, the notification interface 1325 notifies apatient via a voicemail or email. Other notification modes can also beused, depending on the preferences of the patient and medical office.

As shown in the present embodiment, the medical scheduling managementhub 1315 interacts with a patient appointment information database 1335,such as the one shown and described with regard to FIG. 11. Inparticular, the medical scheduling management hub 1315 accesses thepatient appointment information database 1335 when predicting delays andwhen notifying upcoming patients, such as patient 1345. As mentionedwith regard to FIG. 11, the information accessible in the patientappointment information database 1335 is not data that is protectedunder HIPAA.

Although FIGS. 12 and 13 describe particular configurations of medicalscheduling management systems, it should be recognized that variousconfigurations can be constructed within the scope of this disclosure.In addition, the system can be used to provide feedback to the physicianand/or practice to allow them to generate physician/examinationefficiency reports in some examples. For instance, the system cangenerate reports indicating the percentage of appointments that weredelayed and by how much they were delayed. In some cases, the reportscan be customizable to indicate factors such as whether certain types ofappointments are delayed more often, times of day when more appointmentsare delayed, days of the week or month when appointments are delayedmore often, etc. This feedback can be used by the physician to improvetheir care and service and become more efficient in their practice. Thiscan lead to more satisfied patients, a more pleasant experience for thepatients and medical professionals, and a higher rate of return for thephysician and practice.

Although the foregoing concepts have been described in some detail forpurposes of clarity of understanding, it will be apparent that certainchanges and modifications may be practiced within the scope of theappended claims. It should be noted that there are many alternative waysof implementing the processes, systems, and apparatuses. Accordingly,the present embodiments are to be considered as illustrative and notrestrictive.

What is claimed is:
 1. An appointment monitoring system, comprising: afirst beacon corresponding to an individual, wherein the first beacon isconfigured to transmit a wireless signal; a first sensor located withina medical room, wherein the first sensor is reactive to the wirelesssignal or to a position or motion of the first beacon that is in aproximity to the first sensor, wherein the first sensor transmits apulse signal with a first duration when the first beacon is in theproximity to indicate a presence of the individual in the medical room,wherein the first sensor transmits the pulse signal with a secondduration when the first beacon leaves the proximity to indicate an exitof the individual from the medical room; an appointment databasecomprising scheduling information including a first scheduled time for afirst appointment, a second scheduled time for a second appointment; adelay log accessible through an office interface; a computing deviceprogrammed to display the office interface; and a processor coupled tothe first sensor, wherein the processor comprises logic capable of:receiving an examination start time for the first appointmentcorresponding to when the first sensor transmits the pulse signal withthe first duration, subtracting the first scheduled time from theexamination start time to compute a first delay, and transmitting thefirst delay to the delay log.
 2. The system of claim 1, furthercomprising a patient notification interface communicatively coupled tothe appointment database and at least one patient device.
 3. The systemof claim 2, wherein the patient device comprises a telephone and thepatient notification interface alerts a patient to the first delay by atext message or a voicemail.
 4. The system of claim 2, wherein thepatient device comprises a computing device and the patient notificationinterface alerts a patient to the first delay by an email or a pushnotification.
 5. The system of claim 2, wherein the appointment databasefurther comprises a date and time of an open appointment slot, andwherein the patient notification interface sends details of the openappointment slot to the patient device.
 6. The system of claim 5,wherein the patient notification interface accepts a reschedulingmessage from the patient device indicating a selection of the openappointment slot and responsively updates at least one of the secondscheduled time or the appointment database.
 7. The system of claim 2,wherein the patient notification interface causes the patient device todisplay an option of keeping or rescheduling a delayed appointment. 8.The system of claim 1, wherein the first sensor activates an alert inresponse to the first beacon passing through a doorway.
 9. The system ofclaim 1, wherein the individual corresponding to the first beacon is afirst medical worker or a first patient corresponding to the firstappointment, and wherein the first beacon is carried or worn by thefirst medical worker or the first patient.
 10. The system of claim 1,wherein the processor further comprises logic capable of: determiningthat the first delay is greater than a delay threshold; and overwritingthe second scheduled time if the first delay is greater than the delaythreshold.
 11. A non-transitory machine-readable storage mediumprogrammed with code that, when executed, causes at least one machine toperform actions comprising: detecting, via a first sensor located withina medical room, a position or a motion of a first beacon in proximity tothe first sensor, the first beacon corresponding to an individual,wherein the first sensor transmits a pulse signal with a first durationwhen the first beacon is in the proximity to indicate a presence of theindividual in the medical room, wherein the first sensor transmits thepulse signal with a second duration when the first beacon leaves theproximity to indicate an exit of the individual from the medical room;retrieving scheduling information from an appointment database, thescheduling information including a plurality of appointments andcorresponding scheduled times and duration for each appointment, whereinthe scheduling information includes a first scheduled time for a firstappointment and a second scheduled time for a second appointment; andvia a processor coupled to the first sensor, logging an examinationstart time corresponding to when the first sensor transmits the pulsesignal with the first duration, subtracting the first scheduled timefrom the examination start time to compute a first delay, anddetermining that the first delay is greater than a delay threshold,adding the first delay to the second scheduled time to compute a revisedtime associated with the second appointment; and transmitting anotification to a communication device associated with a second patientcorresponding to the second appointment, the notification including therevised time.
 12. The non-transitory machine-readable storage medium ofclaim 11, wherein the actions further comprise: displaying a selectable“keep” option and a selectable list of open appointments on thecommunication device after transmitting the notification; in response toa selection of the selectable “keep” option, replacing the secondscheduled time with the revised time; and in response to a selection ofa substitute appointment from the selectable list of open appointments,canceling the second appointment and assigning the substituteappointment to the second patient.
 13. The non-transitorymachine-readable storage medium of claim 11, wherein the communicationdevice comprises a remote device used by the second patient.
 14. Thenon-transitory machine-readable storage medium of claim 11, wherein thecommunication device comprises a mobile device.
 15. The non-transitorymachine-readable storage medium of claim 11, wherein the communicationdevice comprises a computing device used by an office staff.
 16. Thenon-transitory machine-readable storage medium of claim 11, wherein theactions further comprise: transmitting the first delay to a delay logaccessible through an office interface, wherein the office interface isdisplayed via a computing device.
 17. The non-transitorymachine-readable storage medium of claim 11, wherein the individualcorresponding to the first beacon is a first medical worker or a firstpatient corresponding to the first appointment, and wherein the firstbeacon is carried or worn by the first medical worker or the firstpatient.
 18. The non-transitory machine-readable storage medium of claim11, wherein the notification is transmitted as a push notification via apatient notification interface.
 19. The non-transitory machine-readablestorage medium of claim 11, wherein the actions further comprise:programming the first beacon to transmit an identity signal associatedwith the individual; and logging an identity corresponding to theidentity signal along with the examination start time.
 20. Thenon-transitory machine-readable storage medium of claim 11, wherein theactions further comprise: storing a log entry corresponding to the firstdelay in a database; and analyzing the database to identify frequentcauses, lengths, or types of appointment delays.